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Professional discipline

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The Idaho Medical Association has asked the Idaho Board of Medicine to look into sanctioning Dr. Ryan Cole. He is a dermatopathologist who was recently appointed to the Ada County Public Health Board by Ada County Commissioners. The IMA’s gripe against Dr. Cole is based in their reading of the statutes that prescribe lawful patient care.

But the gripe is also based on the public claims Dr. Cole has made, that he has treated patients “from California to Florida” with the questionable Covid drug, Ivermetin. So, their point: if he’s being honest, he has violated the lawful standards for Idaho physicians. It’s up to you, The Idaho Board of Medicine to investigate and determine if he has in fact broken the law, or he’s just a braggart.

I wish the IMA good luck. I also wish the best to Dr. Cole, though I disagree with his self-proclaimed actions. How can you treat such a wide expanse of patients and have a relationship with them? And just how does a pathologist, with no training in patient care have that skill? Is it any different than selling drugs online? Oh yeah, that’s mostly legal too.

But that equivocation I voiced right there is what makes policing myself and my colleagues in the medical profession so difficult for the Idaho Board of Medicine. We rarely confront each other when we see a fellow colleague straying from the “Community Standard” of medicine.

Maybe that’s because we physicians don’t spend much time establishing or reviewing that peer standard anymore. I’m pretty long in the tooth and I can’t say I have ever seen that practice in the community. It should be.

We did it in medical school and residency. We presented our “cases” (sick people) to each other with an older doc in attendance and we critiqued our diagnoses, our care decisions. I had thought this was how the medical culture would be once I got out into the community practicing. But it just didn’t happen. I wish it would.

I have some real community experience with this. I was the Chief of Staff for our local hospital. Any doctor who practiced in the hospital came under the review of the medical staff. But now a days, with the proliferation of “hospitalists”, employed by the hospitals, many doctors never see their patients in the hospital. And the possibility of reviewing their level of care is lost.

But the clinic, the office practice of medicine has never been subject to much scrutiny. The main driver of sanctions has been malpractice suits, civil litigations usually brought by patients unhappy with their treatment. You can see the pressure on physicians to make the patient happy. And then opioids became widespread and “nonaddictive” and doctors made many demanding patients happy; and some dead.

So, the Idaho Board of Medicine is in a difficult position here. They can investigate Dr. Cole, but I’ll bet those “thousands” of patients he has written Ivermectin prescriptions for are pretty happy with his “care”. At least those that are alive will swear by the treatment. Those who succumbed may think the mask-wearing nurses and doctors in the crowded hospitals didn’t give them enough hydroxychloroquine. Can you see the bind our profession has created for ourselves? And for you?

I doubt Dr. Cole has clinical partners who he presents his “cases” to. Remember, he’s a pathologist who is in the business of running lab tests, vials of blood, serum, or urine. There are few colleagues to review one’s care in that setting.

Idaho’s medical practice “Community Standard” is a sham. The medical profession loves it because it makes doctors harder to sue. Idaho’s medical malpractice premiums are very low. To prove negligence the plaintiff must get some other local doc to testify against the defendant. So, like some Idahoans prefer, we are the medical wild west.
 

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